Case Report

An Analysis of Pediatric Scar Progression Over Time

Blaire Slavin Roberta Torres, MSN, RN, PNP-BC; Anne C. Fischer, MD, PhD, MBA

Disclosures

ePlasty. 2018;18(e18) 

In This Article

Discussion

The case that we present serves as a unique opportunity to analyze scar sizes following a procedure to correct the same disease, given that the patients considered are all from the same family with the same diagnosis and similar surgery. The body of scientific literature discussing scar growth from procedures performed during infancy is relatively limited. In 1860, James Paget challenged the assertion that childhood scars do not grow with age. In a lecture to the Royal College of Surgeons of England, he stated, "The scar of the child, when once completely formed, commonly grows as the body does, at the same rate, and according to the same general rule."[5] In 1873, Adams supported Paget's words when he observed that a 21-month-old patient who underwent a surgical procedure to correct congenital varus of both feet had scars that increased in length by approximately 2.5 cm in the span of 7 years.[6] In terms of scarring resulting specifically from open RUQ pyloromyotomy, Harmon[4] noted that the adult patient's scar had grown in both length and width, puckered because of adherence of skin to abdominal muscular fascia, and deepened because of an increase in thickness of subcutaneous adipose tissue since infancy. Harmon's[4] descriptions were also observed in our case report, as seen in the patient's grandmother whose oblique RUQ scar grew 8 cm in length since the procedure was performed in infancy. This was similar to the 4 cm scar growth seen in aunt 1. The grandmother and aunt 1 are perfect illustrations of the potential scar growth often underestimated in surgery on infants. Because of her stunted growth, aunt 2's scar did not see the same drastic growth as her twin, aunt 1. Aunt 2's body did not grow significantly, nor did her scar.

The drive to modify the surgical technique to pyloromyotomy over the years is largely due to wanting to minimize the size of the initial scar, yet the potential for scar growth into adulthood is still highly unappreciated. Haricharan et al[7] revealed that 88% and 85% of the study's subjects would pay more money for their daughter and son, respectively, to have the laparoscopic pyloromyotomy because they prefer its cosmetic outcome over the open RUQ pyloromyotomy. This percentage would most likely increase if the parents were made aware that the initial incision from an open pyloromyotomy may grow significantly in length as the child ages, as evidenced by our case report.

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